
TREASURY DEPARTMENT 
UNITED STATES PUBLIC HEALTH SERVICE 



PUBLIC HEALTH BULLETIN No. 58 

August, 1919. 




OPEN AIR SCHOOLS FOR THE 
REVENTION AND CURE OF TUBERCULOSIS 
AMONG CHILDREN 



B. S. WARREN 
Passed Assistant Surgeon 



PREPARED BY DIRECTION OF THE SURGEON GENERAL 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1919 



TREASURY DEPARTMENT 
UNITED STATES PUBLIC HEALTH SERVICE 



PUBLIC HEALTH BULLETIN No. 58 

August, 1919. 



OPEN AIR SCHOOLS FOR THE 

PREVENTION AND CURE OF TUBERCULOSIS 

AMONG. CHILDREN 



B. S. WARREN 
Passed Assistant Surgeon 



PREPARED BY DIRECTION OF THE SURGEON GENERAL 




WASHINGTON 

GOVERNMENT PRINTING OFFICE 

1919 






ADDITIONAL COPIES 

OF THIS PUBLICATION MAT BE PROCUKED FEOM 

THE SUPERINTENDENT OF DOCUMENTS 

GOVERNMENT PRINTINCr OFFICE 

WASHINGTON, D. C. 

AT 

15 CENTS PER COPY 



0. of :. 

NOV 2% 



OPEN-AIR SCHOOLS FOR THE PREVENmON AND CURE 
OF TUBERCULOSIS AMONG CHILDREN. 



By B. S. Warren, Passed Assistant Surgeon, United States Public Health Service.* 



The subject of outdoor sokools for tuberculous children, or those 
predisposed to this disease is not a new one. The first experiment 
with them was made in Germany as early as 1904. The expression 
"predisposed to tuberculosis" refers to that group of children who 
by reason of inheritance or environment furnish so many cases of 
the disease. 

From the very beginning these schools have proven to be of great 
value, not only in benefitmg the children in these schools, but also 
by demonstrating clearly some of the defects in the public schools. 
A study of the measures directed toward the prevention of tuber- 
culosis shows that the problem is largely an economic one, and until 
economic conditions are adjusted all measures are at best only reme- 
dies which may improve existing conditions. The sanitarian, how- 
ever, can not afford to wait on the adjustment of economic condi- 
tions, but must use every remedy at hand. 

In the outdoor school is found one of the cheapest, simplest, and 
most efficient remedies for the cure and prevention of tuberculosis 
among children. It is beyond the stage of experiment, and is rec- 
ognized as one of the standard remedies. 

As in all antituberculosis work the problem is most acute in the 
congested districts of the large cities and among the people who 
are on the border land of poverty. The mill and factory towns 
with a large population who earn just enough to live from week to 
week, furnish some of the most difficult situations. In these homes 
where poor hygienic conditions are the rule, when the breadwinner 
or other member of the family is stricken with tuberculosis, the 
protection of the children in the home becomes very difficult, if not 
impossible. The patient has usually reached the advanced stage of 
the disease before he is located and when located probably refuses 
to go to the hospital, 

1 This article is based on experience obtained and observations made while acting as medical director of 
the Society for the Relief and Prevention of Tuberculosis, St. Louis, Mo., during a tour of duty in command 
of the United States marine hospital in tliat city. The work was done in connection with other duties 
asan officer of the United States Public Health Se^^iceandin cooperation with the local society. Acknowl- 
edgment is here made of reports received from many principals of open-air schools in different sections of 
the United States. 

(3) 



The strain of supporting the family under ordinary conditions 
has taxed the earnmg capacity of all the workers. This additional 
expense of an invalid in the family is too great, and the breaking 
point is reached. Through it all the children, on account of greater 
susceptibility to tuberculosis and greater dependence, are the greater 
sufferers. 

A careful examination of the children in homes where there is or 
has been an advanced case of tuberculosis will show that a large 
percentage have the disease in some stage. If not actually tuber- 
culous, these children are so frequently reduced physically that they 
readily acquire the disease. Many of them will be fomid below 
weight, undernourished, anaemic, frequently absent from school, 
backward, or in other subnormal condition. This group of children 
are referred to as pre tubercular by the antituberculosis workers. 

The remedy in some instances may be to take such children from 
the home and place them in institutions. This procedure is prac- 
ticable, however, in but few cases, and could not often be enforced 
without a law for compulsory removal. The advisability of break- 
ing up homes for such reasons, even though the necessary laws 
existed for doing so, is seriously questioned. Social workers are 
advising against it and doing all they can to hold the family together 
even under adverse conditions. Leaving the home intact, the 
remedy would be to take these children for as many hours in the 
day as practicable, place them under as nearly ideal hygienic condi- 
tions as possible to restore them to the normal, and at the same 
time prevent them from forming habits of idleness, and return them 
to the pubUo school without the loss of a grade. 

In addition, the children would be taught lessons of hygiene by 
actual practice, and returned to the insanitary homes as missionaries 
of sanitation, who wiU soon improve the conditions of the home. 
This can be done without further laws and without radical changes. 
In fact, most parents are found willing to let the children go to these 
schools. 

The question of pauperizing the family hardly enters into con- 
sideration, because it may be properly looked upon as one form of a 
public school and not a charity. 

The principles of the open-air school are those of personal hygiene, 
fresh air, cleanliness, proper clothing, proper diet, rest, and recreation. 

THE SITE. 

The location of a site is not one of the least difficulties. Accessi- 
biUty as well as the hygienic surroundings must be considered. At 
times, to avoid the smoke and dust of the city, a suburban site must 
be sought. 



The top of a tall building centrally located as to the majority of the 
prospective pupils may, in some cases, prove more practicable than 
the suburbs. In many instances central location may be impossible, 
and no matter how accessible a site may be it will be found that a 
number of children will have to ride long distances. In Chicago, for 
example, while most of the children lived in the 1-mile zone, many 
lived beyond it, and some 4 miles or more away. Other things be- 
ing equal, a suburban location in the woods is to be preferred. 

Much may be said in favor of a wooded suburb on account of the 
nearer approach to natural conditions, with all that this means from 
a hygienic standpoint; and, further, the benefits of such a change in 
environment mean much to the child who has never known anything 
but a tenement home among tall brick buildings. 

Accessibility and hygienic environment are the two main points 
to be considered, and both should be had if possible. If one must be 
sacrificed, accessibility may be given up with better results, as the 
exhaustion of a long ride is offset by the benefits of the change of 
scene and open-air conditions in a wooded suburb. Opposition may 
be met with among the neighboring residents, but this is readily 
overcome by a full explanation as to the nature and harmless char- 
acter of such schools from a sanitary standpoint. 

BUILDING. 

At present two types of open-air schools are recognized- — one in 
which the school and rest room is open on all sides with canvas drop 
curtains for protection against severe cold winds; the other in which 
some available building is converted by removing only one side wall 
and replacing it with hinged window sash. 

No possible objection can be raised to the first plan, as the free 
sweep of the air makes ventilation complete at all times; whereas, 
in the second, when the sash in the open side is closed for protection 
the room becomes a closed one. Then, too, in warm weather the 
breezes may be often shut off by the closed-in sides, and such a room 
can hardly be as comfortable as the one open on all sides. The first 
type with all sides open is therefore recommended whenever prac- 
ticable. 

The first type, or the real out door school, may be constructed on a 
substantial flat-top roof with very little more expense than on the 
ground. It may be cheaper if a kitchen in the building below is 
available for use by the school. 

The accompanying illustration made of the St. Louis Open Air 
School will be found so simple that any ordinary contractor can 
build one like it without further help from an architect. At the same 
time it is so very inexpensive to build that it would be difficult to find 



a building which could be converted at a less cost. As is apparent 
from the drawings, it is nothing more than a long shed substantially 
built with the north Qnd inclosed for bathrooms, kitchen, and store- 
rooms. (Figs. 1 and 2.) 

The dining room is made so that it can be inclosed in winter, but 
all sash and panels are fastened in by screws so that the}'- can be 
removed after the coldest weather is over. The bathrooms, kitchen, 
and dining room are heated by a steam plant located in a small 
cellar under the kitchen. 

The dining room can not be heated above 60° in cold weather, 
whereas the kitchen and bathrooms can be heated to 72° in zero 
weather. The roof is covered with tar paper and gravel, with an open 
space of about 2 or 3 feet between it and the ceiling. The ceiling is 
made necessary to protect against surmner heat. The uninclosed 
space is for the school and rest room. It is protected by 16-mesh 
screen wire, with canvas drop curtains, made so that they can be 
lowered or raised from the inside. They are never lowered except 
for protection from cold winds and rain or snow. Except in the 
coldest weather, the dining room is open; in fact, forms part of the 
same space as the school and rest room when the sash and panels 
are removed. 

The bathrooms are provided with toilets and shower baths with 
hot and cold water. Leading into the bathrooms are dressing 
rooms provided with, individual lockers for each child. The bath- 
rooms are built out from the main shed so as not to cut the flooring 
and at the same time provide a cement floor. The small cellar is 
made necessary in order to accommodate the steam heating plant 
and to get the proper circulation of the steam. It also saves some 
in the fuel bill by being protected in the cellar. A tent is provided 
outside for the night watchman. 

The dimensions (24 by 64 feet) were found to be the least pos- 
sible to accommodate 25 children. By extending the building 5 
feet longer 30 children could be accommodated. To provide for 
more than this number in one plant would hardly be advisable, 
since many would have to travel long distances. Also a greater 
number would tax the capacity of the teacher so that she would not 
be able to give to each child that individual care and attention which 
contributes so much to the success of the school. 

SELECTION OF CHILDREN. 

The selection of the children is not a very difiicult task. Often 
the necessary data are at hand in the files of the school board. If the 
data are not available, the children may be best located tlirough the 
visiting nurse of the antituberculosis society or the records of the 



YH E5T E L E V AT I N 



o-A 




■■■>A 



L.H:y^iLDE.P. (after J. Hal.LynchCo. /ikhitect^) 



FIG, l.-SHOWING FLOOR PLAN AND WEST ELEVATION OF ST. LOUIS OPEN-AIR SCHOOL. 
A Good Illustration of Type of Real Out-Door School. 



dispensary if there be one. In families where one or more members 
have been found to have the disease in moderately advanced or 
advanced state, a high percentage of the children will be found to have 
it in the incipient stage, or to be in such subnormal state that they 
would soon contract the disease. The childi'en in this stage will be 
found to respond promptly to the open-air school treatment. 

Provision should always be made for separate schools for two classes 
of children: (1) The open cases are found to have tubercle bacilli 
in their sputum or other discharges. (2) The closed cases who do 
not show the baciUi in sputum or other discharges, but who are in 
the incipient or pretubercular stage. 

In St. Louis the visiting nurses had no trouble in locating 25 chil- 
dren simply by inducing children from the tubercular infected home to 
go to the dispensary for physical examination and von Pirquet 
tuberculin test. Those selected from these homes by the nurses 
seldom failed to prove to be incipient cases upon examination at 
the dispensary. 

In the course of a few weeks they found they had more than 25 and 
a waiting list was soon on file. A card was made out for each child 
containing all the necessary data as to physical condition, family 
history, social condition, standing in school, etc. 

Suitable forms were provided for continuation of the history so 
that the cards would contain a complete record of each child until 
discharged. The record should be kept up in so far as possible by 
following up the child until it is grown. In most cases the parents 
will be found wilhng to allow their children to attend the school. If 
a proper explanation is made to the parents by a tactful nurse, social 
worker,- or physician, they rarely refuse to allow their children to 
attend. After it becomes known that there is such a school in 
operation many appHcations wiU come in through family physicians. 

It may be advisable to select the children for the first school from 
the closed cases, so as to forestall possible adverse criticism. 

EQUIPMENT. 

The teacher and teaching equipment should be furnished by the 
school board. Of 51 schools reporting on this subject, 15 were 
wholly supported by the board of education and 34 in part. The 
nurse, cook, watchman, subsistence, clothing, etc., should best be 
furnished by the board of health. 

The health department may not be in a position to do so at first, 
but if some volunteer society will begin and demonstrate the results, 
the proper authorities will seldom hesitate to take over the work. 
The subsistence and clothing may not be furnished by the authorities 
for some time. The supplying of these must then depend on the 



8 

efforts of societies interested. These are very essential to the success 
of the enterprise, and no outdoor school should be attempted unless 
proper food and clothing can be provided. 

Especially is this true of the clothing, because the parents are sel- 
dom able to furnish suitable clothing in the winter or in the other sea- 
sons. Ordinary clothing will do until the days begin to grow cold 
in the fall, when heavy underwear and sweaters will have to be pro- 
vided. As the winter comes on the Eskimo suits, gloves, and felt 
top boots will be required, and the dining room will have to be inclosed 
and heated. The Eskimo suits are made out of woolen blankets, cut 
just like pajamas and large enough to fit loosely over the other 
clothing. Wlien made with a rather long jacket the girls do not 
object to wearing the trousers. (Fig. 3.) 

It is well to have foot-warmers in stock for use when necessary, 
but they will seldom be required. 

Shoes and stockings will be found necessary because the majority 
of the children, though they may have good ones, will come to school 
with them soaking wet, if there is any chance of wetting them on the 
way. 

OPERATION. 

The following program will usually be found practicable; 

Arrival, 8-8.30 a. m. 

Shower bath. 

Putting on school clothing. 

Light lunch. 

School work. 

Recess. 

School work. 

Dinner. 

Rest for one hour. 

School work. 

Light lunch. 

Dismissal 4 p. m., winter; 6 p. m., summer. 

The teacher should have control of the educational matters, and 
the nurse, under the direction of the visiting physician, should have 
control of all matters affecting the health. 

The children will be able to reach the school by 8,30 even in the 
winter. In the summer it may be advisable to fix an earlier hour for 
the arrival. 

Under direction of the nurse the shower bath should be given each 
morning. The bath in the beginning may have to be tempered to 
suit the individual child, and if they show signs of poor reaction 
they should be wrapped in a warm blanket and given a cup of hot 
milk. Soon all will be able to stand the cold shower. After the 
bath, the school clothing is put on. 



9 

The school clothing is a necessity; few, if any, of the children being 
found to have suitable clothing, which is one of the essentials. The 
personal clothing can then be dried and cared for by the nurse. 

A light lunch should be served before the school duties begin. 
Ordinarily a light lunch will answer, but some of the children may 
require more because they have had Httle or no breakfast before 
.leaving home. None should begin their lessons hungry. 

The school duties can be given according to the condition of each 
child, and the teacher should advise with the doctor on this subject, 
always being careful not to overtax any chHd. The studies should 
be interrupted by exercises, folk dances, or play, as may be deemed 
best by the teacher. For this reason it is not wise to lay down any 
fixed rule for these hours, leaving this to the judgment of the teacher 
in charge. The teacher should be trained to some extent in hygiene 
and physical culture, that she may be alive to the value of this in 
school work, and will know what exercises are needed to develop 
poorly developed chests, extremities, etc. (Fig. 4.) 

The advantage of breaks in the studies is obvious. During the 
midday hour a wholesome hot dinner should be served. 

The diet should be well balanced as to proteids, carbohydrates, and 
fats, but until more is known as to the needs of the diet of a growing 
child a common-sense plan should be followed and under most cir- 
cumstances be mindful of the appetites of the children, supplying at 
first those articles which they have been accustomed to eat with a 
rehsh and gradually train them to the things which are the best in 
the judgment of recognized dietitians. Habits of life of the child 
should not be suddenly changed. Many children must be trained 
before they can eat enough of strange dishes to maintain then? body 
weight and growth, and if forced at once into a recognized standard, 
would lose in weight. When a child fails to gain in weight he should 
be carefully studied by the doctor and a thorough investigation made 
of his home life as well as his physical condition. As an example of 
the importance of this, in the St. Louis school, one of the boys failed 
to gain in weight as he should; upon investigation the nurse found he 
had to get up at 4 a. m. to deliver papers; the money earned, $2 per 
week, was absolutely needed for the family support; the only remedy 
was for the society to pay the mother the $2 per week, provided the 
boy was allowed to sleep until a reasonable hour in the morning. 
The rest hour should be considered one of the important features. 
Cots are much better than rechning chairs; they are more comforta- 
ble and aUow an easy natural position of the body instead of the 
cramped one necessary in a rechning chau\ Cots with a raised head- 
piece are cheap, and are worth the difference in price. (Fig. 5.) 
At first the children will not sleep, but if kept quiet each day for the 
116176°— 19 2 



10 

rest hour, in a few days all will go to sleep promptly and have to be 
waked when the hour is ended. With this rest the children will 
be found fresh and ready for any school work without the driv- 
ing usually necessary in the afternoon hours, even for bright 
healthy children. Before dismissal a Hght lunch should be served 
and the school clothing changed for the personal clothing, which 
should be dry and warm by this time. The duties of the nurse 
should be so arranged that she will have time to investigate the 
home conditions of each child, taking up the special cases first. 
She should have sanitary supervision of the school under direction 
of the doctor, but always cooperate with the teacher to obtain best 
results. The teacher should have aU the equipment necessary 
according to the grades represented by the children. A piano will 
be found very useful on account of the exercises and dances. The 
teacher will soon find that following the outdoor life has made her 
feel brighter and more efficient and not subject to the fag attendant 
upon indoor teaching. If she will rest with the children during the 
rest hour, she will do even better work. 

The cook should be in charge of the kitchen under the direction of 
the nurse, who should arrange for the daily diet. 

All children should be examined before admission, as stated above, 
and monthly or oftener thereafter. As soori as permission of parents 
can be obtained, all defects of eyes, nose, throat, and mouth should 
be looked after in the proper manner. 

RECORDS. 

The records should be kept by nurse and teacher according to the 
division into which it falls. 

The card of each child should be kept carefully up to date. (Forms 
1 and 2.) 

Form l. — As most children come from homes where there is a tuberculous patient, this card, if kept for 
each chUd, will be found useful. (Slightly changed from one used by Society for Rehef and Prevention of 
Tuberculosis, St. Louis, Mo.) 

No Date 



Name Address -r, > Floor. 

Rear.j 

White Col Sex male-female Age Referred by 

In care of doctor Clinic 



The Home. Ten. P. H. F. R. B. H. No. of rooms Ventilation. 

Light-dark. Clean-dirty. 

Is any occupant of home suffering from tuberculosis? 

Does patient sleep alone? Separate bed Separate room 

Light. Dark. On porch In tent Roof 

Condition of house, suggestions as to improvement of home conditions.. . 



Economic Conditions. Income for support of family Rent 

How many to support? Circumstances Sick benefits . 

Insurance Church aid Aid from societies 



11 



The Patient. Conscientious Careless 

liitelligent Ignorant Illiterate Temperate 

Hours in home Hours out of doors 

Baths Disposal of sputum 

The Family. No. in family Adults Children Boarders. 

Neat Untidy Dirty 

Other cases in family Adults Children 

Anyone who should go to clinic 

Recommendations: 

Nurse 



Form 2.— Card for personal record of each child. (Adopted by Society for Relief and Prevention of 
Tuberculosis, St. Louis, Mo.) 

No 

Name 

Address Floor — 

(F. B.) (C. O.) 

Age Sex Color Nationality 4 



Date of birth. 



Male— Female. 



White— Black. 



(Nativity of parents.) 



On admis- 
sion (date). 



Normal. 



On discharge 
(date). 



Gain or loss. 



Grade 

Height 

Weight 

Per cent below weight for height . 

Haemoglobin 

Physical condition 

Mental condition 

Physical defects 

Chest 

Scholarship 



Notes 



Previous illness 


[Reverse side.] 


How was child selected? 


Diagnosis 

Is it a clinic case? 


Tuberculin test 




Are parents at clinic? 


WMrh? 


Notes: 



Weekly weight record. 



Date 




























Weight 




























Date 




























Weight 




























Date 




























Weight 










.. .. 















































Chest measurement. 



Date Admission . 

Chest at nipple line : 

Inspiration inches 

Expiration inches 

At rest inches 



Discharge , 



-inches, 
-inches, 
-inches. 



12 

Temperatures should be taken when there is the shghtest indica-j 
tion for it, always giving the child the benefit of the doubt. A con- 
venient form should be adopted which will show clearly what progress, 
if any, the child is making physically and mentally. 

VACATIONS AND HOLIDAYS. 

There is no necessity for these and if left to the children they will 
probably vote to continue in school the year roimd. It would be 
better if some arrangement could be made for Sunday exercises so 
as to have them come seven days in the week. 

The Saturday attendance seemed to please the children in St. 
Louis, and they unanimously voted to come during the Christmas 
holidays. 

The summer vacation should not be given, but a break may be 
made in the routine by changing the character of the school duties 
to make it appear like a day camp. 

During vacation the children lose much of the gain. Some of this 
loss may, however, be due to the summer heat. 

A loss is noted in the children from Friday to Monday where Satur- 
day is a holiday. 

COST. 

A plant such as the one described above was built and equipped in 
St. Louis for $2,200. This cost may be more ,or less in different 
localities, varying with the cost of labor and material. The expense 
of operation in St. Louis does not exceed $150 per child per annum, 
and this includes all expenses of maintenance and operation, viz., 
food, heating, nurse, cook, watchman, etc., but not the teacher. 
The ration should never exceed 20 cents per day, per child, where 
two lunches and dinner are supplied, and in most cases 15 cents will 
cover this cost. 

The following table shows the itemized cost of one day's ration at 
the Open-Air School, Rochester, N. Y.:^ 



Food materials. 



Amount. Cost 



Food materials. 



Amount. Cost 



Oatmeal box . 

Milk quarts. 

Sugar pounds. 



Total (30 children) 

Per capita 

Lunch at 11 o'clock: 

Milk (30 children).. quarts. 

Per capita 

Dinner: 

Potatoes peck. 

Rump roast beef, .pounds. 

Com cans. 

Apples peck. 

Brown sugar pound . 

Milk quarts. 

Butter pound. 

Bread .loaves. 



Total (30 pupils, 3 teach- 
ers) 



$0. 075 
.36 
.07 



.505 
.0166 

.30 
.01 

~7325~ 
1.12 
.30 
.40 
.006 
.48 
.30 
.20 



3.191 



Per capita 

Afternoon lunch: 

Milk quarts. 

Cocoa (can, ilb.). 

Sugar pound. 

Bread loaves. 



Total 

Per capita 

Total per 1 day. 
Per capita 



SO. 096 



.30 
.115 
.035 
.10 



.55 
.018 
4.54 
.14 



1 From report of Principal Miss Fichtner, 1912. 



13 

The cost per child will be less when the school is operated on a more 
extensive scale, with a hundred or more children. The fact that it 
is so easy of application accounts for the rapid increase in the number 
of such schools. The promptness with which most parents accept 
the opportunity for their children makes it easier; it requires no 
campaign of education and, as a rule, no further laws. Most health 
and school boards find their present laws ample if cooperation is had. 

RESULTS. 

The results are uniformly good. Few of the children fail to show 
a gain in weight, color, appetite, attendance, deportment, and 
scholarship. Of reports received for over 875 children in these 
schools, only 70 showed a loss in weight. Most of the 70 showing 
loss in weight were the open advanced cases, who were admitted too 
late to expect success. 

In about 90 per cent of the children the rate of gain was greater 
than for the normal child, so that at the end of the year children 
who were on admission 10 to 15 per cent below the normal weight, in 
proportion to height, showed not only the normal gain in proportion 
to increase in height, but gained so that there were only 6 to 9 per 
cent below the normal. (Figs. 6, 7, and 8.) 

Where control tests were made, the open-air children showed a 
greater gain than did the normal children in the rooms of the public 
schools. 

During vacations some loss was almost invariably shown but 
where records were carefully kept they never showed a loss of all the 
gain. Tables of weekly weights show slight losses at the beginning 
of the summer before the vacation. This same loss is shown in the 
controls of healthy children of the public schools. 

Marked improvement was shown in the color of nearly all the 
children where records were kept of hemoglobin tests. In a large per- 
centage of cases it reached normal, whereas that of the healthy 
children used as controls on the test showed a decline through the 
spring months, falling below normal. (Figs. 9 and 10.) 

The attendance is greatly improved. During the coldest days in 
St. Louis, when the thermometer was below zero, 22 of the 25 chil- 
dren were present. The percentage of absentees is much less than 
in the public schools. 

The progress in their grades is remarkable, even though they work 
little more than half the time. As compared with the children of 
the public school, they not only keep up in the grades but many 
(nearly 50 per cent) go ahead. The St. Louis open-air class com- 
pleted in 8 months' time the usual amount of work done in the 
public schools and 20 per cent more; in other words, they did in 8 
months the work that the normal child in the indoor public school 



14 



t)P£N A 


iH School 




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Year 


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FIG. 5.— CHART SHOWING PERCENTAGE OF INCREASE IN WEIGHT OF 
TUBERCULOUS CHILDREN OF OPEN-AIR SCHOOL, ROCHESTER, N. Y., 
COMPARED WITH DECREASE IN WEIGHT OF NORMAL CHILDREN OF 
INDOOR PUBLIC SCHOOL OF NEW YORK, N. Y. 

(Made from reports of Superintendent of Schools New York City and Principal of 
Open-Air School, Rochester, N. Y.) 



15 



Open Atn School 


— . St. Loui5 Mo: 


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1911 \ 


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FEG. 7.— CHART SHOWING THE AVERAGE PERCENTAGE 
BELOW WEIGHT OF THE CHILDREN OF THE OPEN- 
AIR SCHOOL AT BEGINNING OF YEAR. AND A NET 
GAIN OF 5 PER CENT IN ADDITION TO NORMAL 
GAIN DUE TO GROWTH. 

(Prepared from Report of the Society for the Relief and Preven- 
tion of Tuberculosis, St. Louis, Mo.) 



16 







Alcu,, V^oi/ /^/rv 








Yeai- 


1910 


/ <?// \ 


(ItnTi 


Oct 


A/ov. 


Ok. 


Jan. 


Fee. 


Mah. 


flPR. 


May 


,3 


















2 




2.1 


"^-^ 


"^^ 










/ 












-,y^ 


\ 




D 


Lin 


£ OF 1 


^OKMi 


L Yit 


'G//r 


roK H 


\ 




1 
















\ 
\ 


1 
















/> 


d 


















4 


















6 


















6 














6 




7 












/ 


^\ 


s. 


? 












/ 




> 


9 










y 








10 




y 


/•9-r 












// 


/ 


/ 














11 


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ANefiic Class. 
"■"— ~" *~ "~- AIorhal CtAii, 

FIG. 8.— CHART SHOWING PERCENTAGE OF GAIN IN 
WEIGHT OF ANEMIC CLASS IN OPEN-AIR SCHOOL, 
AND LOSS IN WEIGHT OF NORMAL CLASS IN INDOORS 
ROOM OF PUBLIC SCHOOL. 

(Thirteenth Annual Report of City Superintendent of Schools, 
New York City, 1910-11.) 



17 



Oi^EN Aip Class 






Kt 


fw York CtfY. 


■ III , , ,^ 


Year 


19 10 


19 1 > 1 


Monlh 


Oct. 


Nov. 


Dec. 


Jan 


Feb. 


NAtt. 


flffi. 


M/IY. 


Jum 


90 


, 














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-,- 





— — — •- NeiwAL Cutis. 

FIG. 9.— CHART SHOWING GAIN IN PERCENTAGE OF 
HAEMOGLOBIN COLORING OF BLOOD OF ANEMIC 
CLASS IN OPEN-AIR SCHOOL. AND LOSS IN NORMAL 
CLASS IN INDOOR ROOM OF PUBLIC SCHOOL. 

(Thirteenth Annual Report of City Superintendent of Schools, 
New York City, 1910-11.) 



18 



Op£n Am School 






— BoCHBi 


TEH.N.Y 


Year 


f9/f 


/ 9 / 2 1 


Month 


Sept. 


Oct. 


Nov. 


Dec. 


Jan. 


Feb. 


Mar 


Apr. 


May 


m. 




















JSL 




















n 




















sy 








V, 


J? 


r 








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11. 




















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SVBNORMAL CuiiS, IKOCHESTEH.N.Y. 



""" ~-- "— — ^ NoHMAL Ci^si, A/eit YoKH C/TY. 

FIG. 10.— CHART SHOWING AVERAGE GAIN IN PERCENT- 
AGE OF HAEMOGLOBIN COLORING OF BLOOD OF 
THE CHILDREN OF SUBNORMAL CLASS IN OPEN-AIR 
SCHOOL, ROCHESTER, N. Y., COMPARED WITH THE 
LOSS SHOWN IN CHILDREN OF NORMAL CLASS IN 
INDOOR ROOM OF THE PUBLIC SCHOOL OF NEW 
YORK CITY. 

(Prepared from Reports of Principal of Open-Air School, Roches- 
ter, N. Y., and Thirteenth Annual Report of City Superintendent 
of Schools, New York City, 1910-11.) 



19 

would do in 9^ months. One class in New York City which was 19 
per cent below grade on admission in October was only 9 per cent 
below the following June, making the normal progress plus 10 per 
cent more than the child of the public schools. They never seem 
to fag, and are as ready to do arithmetic in the afternoon as in the 
morning and are as fresh and alert when dismissed as on arrival. 

In considering these results it is impossible with the present data 
to say to which of the features these results are due. 

The constant factors present in all the schools are fresh air, proper 
clothing, and proper diet; the other features — rest, recreation, and 
bathing — are not common to all. The good results are obtained with 
the first, but results are somewhat better when the latter are added 
as part of the routine. Another feature which should not be lost 
sight of in considering the results in scholarship is the teacher. 
Usually an exceptional teacher is selected, and she has more time 
with 25 children to make the teaching more individual. The results 
are so satisfactory in every case that the open-air school can no 
longer be classed as an experiment, but may now be relied upon as 
one of the most practical remedies for the mentally and physically 
subnormal child, and certainly one of the cheapest. 

Now that the benefits to the subnormal child are so thoroughly 
proven and accepted, why not apply the same principle to the nor- 
mal child ? Wliy not give it the same advantages ? The results 
would probably be just as satisfactory. The plan is even more 
practicable in the case of the healthy child, since in a great majority 
of cases its parents are able to supply proper diet and clothing if the 
school board will supply the open-air rooms and the information as 
to proper diet and clothing. Wonderful progress has been made in 
ventilating devices, but as yet none are successful except when 
operated by expert engineers, and consequently when operated by 
ordinary janitors fail to ventilate. UntU the amount of air and 
moisture supplied at the proper temperature can be relied on, in spite 
of the changing weather conditions and lack of technical training 
on the part of the janitors, all schools should be open-air schools. 

It is a simple matter to open the windows, provided the children 
are properly clothed and fed by the parents when they are able and 
by the proper authorities when they are not able. Under our 
present economic conditions no other remedy offers such wonderful 
possibilities for good as the open-air schools for all children. The 
truth of such a statement is apparent when we consider the impor- 
tance of the health of the children of the country and the possibilities 
of a remedy for maintaming the normal children up to that standard, 
and surely such results may be expected for the normal child when 
results show such marked improvement in 90 per cent of subnormal 
children. 



20 

The following table showing average weight, height, and ciixjum- 
ference of chest of children from sLxth to sixteenth year, prepared 
from weights and measurements of large numbers of apparently- 
healthy children by Porter, of St. Louis, and Bowditch, of Boston, 
is published for the convenience of those who may wish to use it for 
reference in keeping records : 

[This table was prepared from tables published in the Diseases of Infancy and Childhood, by L. Emmet 
Holt, M. D., LL. D., 2d edition, 1904, pp. 19 and 20.] 





Sex. 


Porter. 


Bowditch. 


Age. 


Weight. 


Weight. 


Height. 


Chest. 




Pounds. 


Kilos. 


Pounds. 


Kilos. 


Inches. 


Centi- 
meters. 


Inches. 


Centi- 
meters. 


6 


Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 

Boy 

Girl 


43.2 
41.3 

47.7 
45.8 

52.6 
50.0 

57.4 
55.1 

62.7 
60.3 

68.8 
65.8 

73.6 
73.0 

79.1 
84.2 

88.7 
94.9 

103.9 
103.2 

114.6 
110.1 


19.66 
18.76 

21.67 
20.82 

23.91 
22.71 

26.08 
25.07 

28.49 
27.43 

31.26 
29.93 

33.45 
33.17 

35.96 
38.29 

40.34 
43.12 

47.25 
46.90 

52.10 
50.06 


45.1 
43.8 

45.5 
48.0 

54.5 
52.9 

60.0 
57.5 

66.6 
64.1 

72.4 
70.3 

79.8 
81.4 

88.3 
91.2 

99.3 
100.3 

110.8 
108.4 

123.7 
113.0 


20.48 
19.87 

22.44 
21.78 

24. 70 
24.01 

26.58 
26.10 

30.22 
29.07 

32.83 
31.87 

36.21 
36.90 

40.04 
41.36 

45.03 
45.50 

50.26 
49. 17 

56.09 
51.24 


44.1 
43.6 

46.2 
45.9 
48.2 
48.0 

50.1 
49.6 

52.2 
51.8 

54.0 
53.8 

55.8 
57.1 

58.2 
58.7 

61.0 
60.3 

63.0 
61.4 

65.6 
61.7 


112.0 
110.9 

117.4 
116.7 

122.3 
122.1 

127.2 
126.0 

132.6 
131.5 

137.2 
136.6 

■ 141.7 
145.2 

147.7 
149.2 

155.1 
153.2 

159.9 
155.9 

166.5 
J56.7 


23.2 

22.8 

23.7 
23.3 
24.4 
23.8 

25.1 
24.5 

25.8 
24.7 

26.4 
25.8 

27.0 
26.8 

27.7 
28.0 

28.8 
29.2 

30.0 
30.3 

31.2 
30.8 


59.1 


7 


58.3 
60.6 


8 


59.5 
62.2 


9 


60.8 
63.9 


10 


62.5 
65.6 


11 


63.0 
67.2 


12 


65.8 
68.8 


13 


68.3 
70.6 


14 


71.3 
73.3 


15 


74.1 
76.6 


16 


76.8 
79.2 




78.8 



o 



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